Catheterization and Cardiovascular Interventions 84:987–991 (2014)
Case Report Survival With Good Neurological Outcome in a Patient With Prolonged Ischemic Cardiac Arrest—Utility of Automated Chest Compression Systems in the Cardiac Catheterization Laboratory Peter J. Psaltis,* MBBS, PhD, Ian T. Meredith, MBBS, PhD, and Walid Ahmar, MBBS, PhD The management of refractory cardiac arrest during invasive coronary procedures has substantial logistical challenges and is typically associated with disappointing outcomes. We describe the case of a young woman with recalcitrant ventricular fibrillation due to acute anterior ST-elevation myocardial infarction caused by occlusion of her proximal left anterior descending artery. Survival without neurological deficit or organ failure was achieved following primary percutaneous reperfusion and a total of 52 min of intra-procedural chest compression support, made possible by the use of an automated chest compression device. VC 2014 Wiley Periodicals, Inc. Key words: cardiopulmonary resuscitation; myocardial infarction; percutaneous coronary intervention; ventricular fibrillation
INTRODUCTION
Coronary heart disease is the leading cause of cardiac arrest, with high prevalence of acute coronary occlusion in patients found to be in ventricular fibrillation (VF) or other rhythms associated with pulseless electrical activity (PEA). Outcomes of resuscitated patients after cardiac arrest complicating acute myocardial infarction remain poor, particularly where there is delay in the initiation of effective cardiopulmonary resuscitation (CPR) and where the interval between onset of cardiac arrest and return of spontaneous circulation (ROSC) is prolonged. The importance of establishing early myocardial reperfusion by expeditious angiography and percutaneous coronary intervention (PCI) is well established and accentuated in cases of recalcitrant ischemic VF or PEA. In such instances, maintenance of cardiopulmonary support, including effective closed chest compressions, is required at least until restoration of adequate blood flow in the culprit coronary artery. Manual chest compression is ergonomically challenging during PCI. Staff performing CPR are directly in the field of radiation exposure and angiographic view, hindering image quality. Furthermore, interruptions to CPR are often C 2014 Wiley Periodicals, Inc. V
necessary to enable various procedural maneuvers, while the effectiveness and consistency of manual compressions is also compromised by fatigue and the need for staff to rotate through prolonged CPR. Mechanical or automated CPR (A-CPR) devices may circumvent these challenges, by achieving more consistent and superior compressions, avoiding resuscitator fatigue, removing resuscitators from radiation proximity and the imaging field and minimizing interruption to cardiopulmonary support. This case report describes a young lady with refractory cardiac arrest MonashHeart, Monash Medical Centre, Clayton, Victoria, Australia Conflict of interest: Nothing to report. *Correspondence to: Dr. Peter J. Psaltis, MonashHeart, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, Australia 3168. E-mail: [email protected] Received 8 October 2013; Revision accepted 3 January 2014 DOI: 10.1002/ccd.25368 Published online 29 January 2014 in Wiley Online Library (wileyonlinelibrary.com)
988
Psaltis et al.
secondary to acute anterior ST-elevation myocardial infarction (STEMI), in whom prolonged A-CPR in the cardiac catheterization laboratory (CCL) helped achieve an excellent outcome. CASE REPORT
A 41-year-old female smoker with several days of recent chest pain, developed an episode of severe chest pain while at home. She was attended to by emergency medical services officers within 20 min, but soon after developed VF from which she was successfully reverted with one defibrillation shock. An electrocardiogram (EKG) demonstrated acute anterior STEMI and the primary angioplasty team was pre-notified before hospital transfer, allowing the patient to be brought directly to the CCL, which was achieved within 75 min of initial onset of chest pain. At the time of CCL arrival, the patient still had chest pain, although she was hemodynamically stable in sinus rhythm with heart rate 74 bpm and blood pressure 110/85 mm Hg. While being transferred from gurney to CCL table, the patient went into VF again and cardiac arrest. Manual CPR was commenced immediately; however, normal rhythm and spontaneous cardiac output were not restored despite a total of 12 defibrillation attempts. Adrenaline (31 mg boluses, followed by infusion) and amiodarone (300 mg bolus, followed by infusion) were given intravenously and she was intubated and ventilated. Right femoral arterial access was obtained with a 6 Fr sheath. At this time, chest compressions were interrupted briefly (15 mm Hg and TIMI grade 3 flow in four of six patients, in whom duration of resuscitation ranged between 30 and 150 min; however, only two survived the first 24 hr [8]. Similarly, in a US series of five patients experiencing sudden cardiac arrest in the CCL (four with STEMI and one during elective PCI), there was only one survivor [9]. Finally, in a Swedish retrospective study of A-CPR performed in 43 patients (33 STEMI, 7 NSTEMI, 2 elective PCI, 1 cardiac tamponade), Wagner et al. reported that 12 survived to hospital discharge, with 11 having good neurological outcome, after initial success in 27 of 36 PCI procedures [10]. In that cohort, average time of CPR support was 28.2 min (range 1–90 min) overall and 16.5 min (1–50 min) for survivors. The authors concluded that survival rates would have been much lower without the use of LUCASTM. A recent overview highlighted that survival is extremely poor if patients arrive to the CCL already receiving A-CPR without ROSC and recommended against routine activation of the CCL in such cases [12]. In the patient described here, several favorable factors contributed to good long-term outcome, despite the fact that she was without spontaneous circulatory output for over 50 min. Firstly, she was young and without significant pre-existing comorbidities. Prenotification from ambulance staff enabled immediate transfer to the CCL, avoiding delays in the emergency department. She presented within normal working hours and arrived in a fully conscious, hemodynamically stable state before arresting while being positioned on the CCL table. Numerous staff were present to assist with immediate commencement of manual resuscitation including activating anesthetic support,
while the interventional scrub team urgently prepared for angiography. Once it became apparent that A-CPR would be required for angiography to proceed, there was adequate support and expertise available to transition smoothly to the LUCASTM 2 device, with only brief interruption to manual CPR while preparing and positioning the A-CPR system. This was further facilitated by the fact that this patient weighed 60 kg; both the effectiveness of CPR and the process of placing the back-board of the A-CPR device under a patient already on the CCL table are far more challenging in obese patients, especially if staff numbers are limited, as for after-hours primary PCI. It is crucial for all staff on primary PCI rosters to be appropriately trained in the use of A-CPR devices. In the case of LUCASTM, the learning curve is relatively straight forward; however, staff must maintain familiarity and confidence with its use, especially for those who have had only limited experiences with the device in real-world situations. Although we do not routinely adopt an A-CPR set-up for all elective or STEMI PCI procedures, the current case has prompted us to prepare the LUCASTM 2 device before positioning high risk patients on the CCL table, such as those who have already required resuscitative measures prior to their arrival. As depicted here, our institution also routinely uses therapeutic hypothermia after PCI in STEMI complicated by prolonged cardiac arrest, although we acknowledge that the optimal time for its initiation remains debated [13]. In the present example, A-CPR was fundamental in allowing the provision of sustained and effective chest compressions during PCI, without compromising the safety of our resuscitator staff or prohibitively obstructing the angiographic imaging field. The LUCASTM device mostly consists of plastic fabric that is radiolucent. Adequate fluoroscopic imaging is usually possible throughout A-CPR, albeit by using sufficient left or right anterior oblique projections and cranial or caudal angulations to shift the device components from the angiographic field of view. This itself poses extra challenges as conventional AP views, which may be preferred for left main coronary engagement, are generally unusable. Effective fluoroscopic views may be even more limited in obese patients in whom visibility is suboptimal for steep caudal projections. These issues add considerably to the complexity of primary PCI during cardiac arrest and A-CPR, as do the difficulties inherent in achieving catheter engagement, accurate balloon and stent placement and assessment of coronary TIMI flow grade during cardiac compressions. In the present case, we temporarily interrupted automated compressions during stent positioning and deployment in the proximal LAD, while in other cases we have
Catheterization and Cardiovascular Interventions DOI 10.1002/ccd. Published on behalf of The Society for Cardiovascular Angiography and Interventions (SCAI).
Prolonged Automated CPR During Primary PCI
also done this for engagement and wiring particularly of culprit right coronary arteries. Although brief, these interruptions lead to further prolongation of tissue hypoperfusion. While automated CPR devices have become widely available, their acquisition has not necessarily been prioritized by all CCLs in developed countries. By comparison, other strategies to provide myocardial and circulatory support in the setting of STEMI with shock or cardiac arrest, such as IABP counterpulsation, percutaneous left ventricular assist devices (LVADs) (e.g., Impella), and extracorporeal membrane oxygenation (ECMO), are more costly and generally less readily accessible. In experimental studies, mechanical myocardial unloading has resulted in biological benefits on infarct size, microcirculatory function, and increased LV recovery. Rapid initiation of ECMO in the CCL before PCI has been advocated as a means to obtain full cardiac support and perfusion of vital organs immediately, including cerebral cooling, with encouraging clinical results [14]. However, the implementation of up-front IABP, ECMO, or LVADs carries considerable challenges and risks, requiring specific skill-sets and expertise and has not yet definitively translated to benefit in long-term patient survival [15]. Moreover, at present it remains undetermined as to whether time to mechanical circulatory support is more important than time to coronary reperfusion. In this case we therefore prioritized CPR and urgent PCI above other mechanical support measures and unfortunately were subsequently precluded from inserting an IABP or performing high bore ECMO cannulation because of severe catecholamine-induced constriction of the peripheral arteries.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
CONCLUSION
Despite inherent limitations and the absence of randomized data to validate their benefit, A-CPR devices are practical and useful adjuncts to the complex management of refractory cardiac arrest in the CCL setting, especially in selected patients in whom positive outcomes are still achievable and extremely rewarding.
13.
14.
REFERENCES 1. Azman KJ, Gorjup V, Noc M. Rescue percutaneous coronary intervention during cardiopulmonary resuscitation. Resuscitation 2004;61:231–236. 2. Rubertsson S, Karlsten R. Increased cortical cerebral blood flow with LUCAS; a new device for mechanical chest compressions
15.
991
compared to standard external compressions during experimental cardiopulmonary resuscitation. Resuscitation 2005;65:357–363. Kramer-Johansen J, Pytte M, Tomlinson AE, Sunde K, Dorph E, Svendsen JV, et al. Mechanical chest compressions with trapezoidal waveform improve haemodynamics during cardiac arrest. Resuscitation 2011;82:213–218. Wyss CA, Fox J, Franzeck F, Moccetti M, Scherrer A, Hellermann JP, et al. Mechanical versus manual chest compression during CPR in a cardiac catheterisation setting. Cardiovasc Med 2010;13:92–96. Hallstrom A, Rea TD, Sayre MR, Christenson J, Anton AR, Mosesso VN Jr, et al. Manual chest compression vs use of an automated chest compression device during resuscitation following out-of-hospital cardiac arrest: a randomized trial. JAMA 2006;295:2620–2628. Ong ME, Ornato JP, Edwards DP, Dhindsa HS, Best AM, Ines CS, et al. Use of an automated, load-distributing band chest compression device for out-of-hospital cardiac arrest resuscitation. JAMA 2006;295:2629–2637. Grogaard HK, Wik L, Eriksen M, Brekke M, Sunde K. Continuous mechanical chest compressions during cardiac arrest to facilitate restoration of coronary circulation with percutaneous coronary intervention. J Am Coll Cardiol 2007;50:1093–1094. Larsen AI, Hjornevik A, Bonarjee V, Barvik S, Melberg T, Nilsen DW. Coronary blood flow and perfusion pressure during coronary angiography in patients with ongoing mechanical chest compression: A report on 6 cases. Resuscitation 2010;81:493– 497. Azadi N, Niemann JT, Thomas JL. Coronary imaging and intervention during cardiovascular collapse: Use of the LUCAS mechanical CPR device in the cardiac catheterization laboratory. J Invasive Cardiol 2012;24:79–83. Wagner H, Terkelsen CJ, Friberg H, Harnek J, Kern K, Lassen JF, et al. Cardiac arrest in the catheterisation laboratory: A 5year experience of using mechanical chest compressions to facilitate PCI during prolonged resuscitation efforts. Resuscitation 2010;81:383–387. Larsen AI, Hjornevik AS, Ellingsen CL, Nilsen DW. Cardiac arrest with continuous mechanical chest compression during percutaneous coronary intervention. A report on the use of the LUCAS device. Resuscitation 2007;75:454–459. Kalra A, Maharaj V, Johannsen RA, Hollenberg SM. Catheterization laboratory activation during mechanical cardiopulmonary resuscitation: When should we say “No?” Catheter Cardiovasc Interv 2014;83:58–64. Brown DF, Jaffer FA, Baker JN, Gurol ME. Case records of the Massachusetts General Hospital. Case 28-2013. A 52-year-old man with cardiac arrest after an acute myocardial infarction. N Engl J Med 2013;369:1047–1054. Kagawa E, Dote K, Kato M, Sasaki S, Nakano Y, Kajikawa M, et al. Should we emergently revascularize occluded coronaries for cardiac arrest? Rapid-response extracorporeal membrane oxygenation and intra-arrest percutaneous coronary intervention. Circulation 2012;126:1605–1613. Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, et al. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABPSHOCK II): Final 12 month results of a randomised, open-label trial. Lancet 2013;382:1638–1645.
Catheterization and Cardiovascular Interventions DOI 10.1002/ccd. Published on behalf of The Society for Cardiovascular Angiography and Interventions (SCAI).
Case Report Survival With Good Neurological Outcome in a Patient With Prolonged Ischemic Cardiac Arrest—Utility of Automated Chest Compression Systems in the Cardiac Catheterization Laboratory Peter J. Psaltis,* MBBS, PhD, Ian T. Meredith, MBBS, PhD, and Walid Ahmar, MBBS, PhD The management of refractory cardiac arrest during invasive coronary procedures has substantial logistical challenges and is typically associated with disappointing outcomes. We describe the case of a young woman with recalcitrant ventricular fibrillation due to acute anterior ST-elevation myocardial infarction caused by occlusion of her proximal left anterior descending artery. Survival without neurological deficit or organ failure was achieved following primary percutaneous reperfusion and a total of 52 min of intra-procedural chest compression support, made possible by the use of an automated chest compression device. VC 2014 Wiley Periodicals, Inc. Key words: cardiopulmonary resuscitation; myocardial infarction; percutaneous coronary intervention; ventricular fibrillation
INTRODUCTION
Coronary heart disease is the leading cause of cardiac arrest, with high prevalence of acute coronary occlusion in patients found to be in ventricular fibrillation (VF) or other rhythms associated with pulseless electrical activity (PEA). Outcomes of resuscitated patients after cardiac arrest complicating acute myocardial infarction remain poor, particularly where there is delay in the initiation of effective cardiopulmonary resuscitation (CPR) and where the interval between onset of cardiac arrest and return of spontaneous circulation (ROSC) is prolonged. The importance of establishing early myocardial reperfusion by expeditious angiography and percutaneous coronary intervention (PCI) is well established and accentuated in cases of recalcitrant ischemic VF or PEA. In such instances, maintenance of cardiopulmonary support, including effective closed chest compressions, is required at least until restoration of adequate blood flow in the culprit coronary artery. Manual chest compression is ergonomically challenging during PCI. Staff performing CPR are directly in the field of radiation exposure and angiographic view, hindering image quality. Furthermore, interruptions to CPR are often C 2014 Wiley Periodicals, Inc. V
necessary to enable various procedural maneuvers, while the effectiveness and consistency of manual compressions is also compromised by fatigue and the need for staff to rotate through prolonged CPR. Mechanical or automated CPR (A-CPR) devices may circumvent these challenges, by achieving more consistent and superior compressions, avoiding resuscitator fatigue, removing resuscitators from radiation proximity and the imaging field and minimizing interruption to cardiopulmonary support. This case report describes a young lady with refractory cardiac arrest MonashHeart, Monash Medical Centre, Clayton, Victoria, Australia Conflict of interest: Nothing to report. *Correspondence to: Dr. Peter J. Psaltis, MonashHeart, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, Australia 3168. E-mail: [email protected] Received 8 October 2013; Revision accepted 3 January 2014 DOI: 10.1002/ccd.25368 Published online 29 January 2014 in Wiley Online Library (wileyonlinelibrary.com)
988
Psaltis et al.
secondary to acute anterior ST-elevation myocardial infarction (STEMI), in whom prolonged A-CPR in the cardiac catheterization laboratory (CCL) helped achieve an excellent outcome. CASE REPORT
A 41-year-old female smoker with several days of recent chest pain, developed an episode of severe chest pain while at home. She was attended to by emergency medical services officers within 20 min, but soon after developed VF from which she was successfully reverted with one defibrillation shock. An electrocardiogram (EKG) demonstrated acute anterior STEMI and the primary angioplasty team was pre-notified before hospital transfer, allowing the patient to be brought directly to the CCL, which was achieved within 75 min of initial onset of chest pain. At the time of CCL arrival, the patient still had chest pain, although she was hemodynamically stable in sinus rhythm with heart rate 74 bpm and blood pressure 110/85 mm Hg. While being transferred from gurney to CCL table, the patient went into VF again and cardiac arrest. Manual CPR was commenced immediately; however, normal rhythm and spontaneous cardiac output were not restored despite a total of 12 defibrillation attempts. Adrenaline (31 mg boluses, followed by infusion) and amiodarone (300 mg bolus, followed by infusion) were given intravenously and she was intubated and ventilated. Right femoral arterial access was obtained with a 6 Fr sheath. At this time, chest compressions were interrupted briefly (15 mm Hg and TIMI grade 3 flow in four of six patients, in whom duration of resuscitation ranged between 30 and 150 min; however, only two survived the first 24 hr [8]. Similarly, in a US series of five patients experiencing sudden cardiac arrest in the CCL (four with STEMI and one during elective PCI), there was only one survivor [9]. Finally, in a Swedish retrospective study of A-CPR performed in 43 patients (33 STEMI, 7 NSTEMI, 2 elective PCI, 1 cardiac tamponade), Wagner et al. reported that 12 survived to hospital discharge, with 11 having good neurological outcome, after initial success in 27 of 36 PCI procedures [10]. In that cohort, average time of CPR support was 28.2 min (range 1–90 min) overall and 16.5 min (1–50 min) for survivors. The authors concluded that survival rates would have been much lower without the use of LUCASTM. A recent overview highlighted that survival is extremely poor if patients arrive to the CCL already receiving A-CPR without ROSC and recommended against routine activation of the CCL in such cases [12]. In the patient described here, several favorable factors contributed to good long-term outcome, despite the fact that she was without spontaneous circulatory output for over 50 min. Firstly, she was young and without significant pre-existing comorbidities. Prenotification from ambulance staff enabled immediate transfer to the CCL, avoiding delays in the emergency department. She presented within normal working hours and arrived in a fully conscious, hemodynamically stable state before arresting while being positioned on the CCL table. Numerous staff were present to assist with immediate commencement of manual resuscitation including activating anesthetic support,
while the interventional scrub team urgently prepared for angiography. Once it became apparent that A-CPR would be required for angiography to proceed, there was adequate support and expertise available to transition smoothly to the LUCASTM 2 device, with only brief interruption to manual CPR while preparing and positioning the A-CPR system. This was further facilitated by the fact that this patient weighed 60 kg; both the effectiveness of CPR and the process of placing the back-board of the A-CPR device under a patient already on the CCL table are far more challenging in obese patients, especially if staff numbers are limited, as for after-hours primary PCI. It is crucial for all staff on primary PCI rosters to be appropriately trained in the use of A-CPR devices. In the case of LUCASTM, the learning curve is relatively straight forward; however, staff must maintain familiarity and confidence with its use, especially for those who have had only limited experiences with the device in real-world situations. Although we do not routinely adopt an A-CPR set-up for all elective or STEMI PCI procedures, the current case has prompted us to prepare the LUCASTM 2 device before positioning high risk patients on the CCL table, such as those who have already required resuscitative measures prior to their arrival. As depicted here, our institution also routinely uses therapeutic hypothermia after PCI in STEMI complicated by prolonged cardiac arrest, although we acknowledge that the optimal time for its initiation remains debated [13]. In the present example, A-CPR was fundamental in allowing the provision of sustained and effective chest compressions during PCI, without compromising the safety of our resuscitator staff or prohibitively obstructing the angiographic imaging field. The LUCASTM device mostly consists of plastic fabric that is radiolucent. Adequate fluoroscopic imaging is usually possible throughout A-CPR, albeit by using sufficient left or right anterior oblique projections and cranial or caudal angulations to shift the device components from the angiographic field of view. This itself poses extra challenges as conventional AP views, which may be preferred for left main coronary engagement, are generally unusable. Effective fluoroscopic views may be even more limited in obese patients in whom visibility is suboptimal for steep caudal projections. These issues add considerably to the complexity of primary PCI during cardiac arrest and A-CPR, as do the difficulties inherent in achieving catheter engagement, accurate balloon and stent placement and assessment of coronary TIMI flow grade during cardiac compressions. In the present case, we temporarily interrupted automated compressions during stent positioning and deployment in the proximal LAD, while in other cases we have
Catheterization and Cardiovascular Interventions DOI 10.1002/ccd. Published on behalf of The Society for Cardiovascular Angiography and Interventions (SCAI).
Prolonged Automated CPR During Primary PCI
also done this for engagement and wiring particularly of culprit right coronary arteries. Although brief, these interruptions lead to further prolongation of tissue hypoperfusion. While automated CPR devices have become widely available, their acquisition has not necessarily been prioritized by all CCLs in developed countries. By comparison, other strategies to provide myocardial and circulatory support in the setting of STEMI with shock or cardiac arrest, such as IABP counterpulsation, percutaneous left ventricular assist devices (LVADs) (e.g., Impella), and extracorporeal membrane oxygenation (ECMO), are more costly and generally less readily accessible. In experimental studies, mechanical myocardial unloading has resulted in biological benefits on infarct size, microcirculatory function, and increased LV recovery. Rapid initiation of ECMO in the CCL before PCI has been advocated as a means to obtain full cardiac support and perfusion of vital organs immediately, including cerebral cooling, with encouraging clinical results [14]. However, the implementation of up-front IABP, ECMO, or LVADs carries considerable challenges and risks, requiring specific skill-sets and expertise and has not yet definitively translated to benefit in long-term patient survival [15]. Moreover, at present it remains undetermined as to whether time to mechanical circulatory support is more important than time to coronary reperfusion. In this case we therefore prioritized CPR and urgent PCI above other mechanical support measures and unfortunately were subsequently precluded from inserting an IABP or performing high bore ECMO cannulation because of severe catecholamine-induced constriction of the peripheral arteries.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
CONCLUSION
Despite inherent limitations and the absence of randomized data to validate their benefit, A-CPR devices are practical and useful adjuncts to the complex management of refractory cardiac arrest in the CCL setting, especially in selected patients in whom positive outcomes are still achievable and extremely rewarding.
13.
14.
REFERENCES 1. Azman KJ, Gorjup V, Noc M. Rescue percutaneous coronary intervention during cardiopulmonary resuscitation. Resuscitation 2004;61:231–236. 2. Rubertsson S, Karlsten R. Increased cortical cerebral blood flow with LUCAS; a new device for mechanical chest compressions
15.
991
compared to standard external compressions during experimental cardiopulmonary resuscitation. Resuscitation 2005;65:357–363. Kramer-Johansen J, Pytte M, Tomlinson AE, Sunde K, Dorph E, Svendsen JV, et al. Mechanical chest compressions with trapezoidal waveform improve haemodynamics during cardiac arrest. Resuscitation 2011;82:213–218. Wyss CA, Fox J, Franzeck F, Moccetti M, Scherrer A, Hellermann JP, et al. Mechanical versus manual chest compression during CPR in a cardiac catheterisation setting. Cardiovasc Med 2010;13:92–96. Hallstrom A, Rea TD, Sayre MR, Christenson J, Anton AR, Mosesso VN Jr, et al. Manual chest compression vs use of an automated chest compression device during resuscitation following out-of-hospital cardiac arrest: a randomized trial. JAMA 2006;295:2620–2628. Ong ME, Ornato JP, Edwards DP, Dhindsa HS, Best AM, Ines CS, et al. Use of an automated, load-distributing band chest compression device for out-of-hospital cardiac arrest resuscitation. JAMA 2006;295:2629–2637. Grogaard HK, Wik L, Eriksen M, Brekke M, Sunde K. Continuous mechanical chest compressions during cardiac arrest to facilitate restoration of coronary circulation with percutaneous coronary intervention. J Am Coll Cardiol 2007;50:1093–1094. Larsen AI, Hjornevik A, Bonarjee V, Barvik S, Melberg T, Nilsen DW. Coronary blood flow and perfusion pressure during coronary angiography in patients with ongoing mechanical chest compression: A report on 6 cases. Resuscitation 2010;81:493– 497. Azadi N, Niemann JT, Thomas JL. Coronary imaging and intervention during cardiovascular collapse: Use of the LUCAS mechanical CPR device in the cardiac catheterization laboratory. J Invasive Cardiol 2012;24:79–83. Wagner H, Terkelsen CJ, Friberg H, Harnek J, Kern K, Lassen JF, et al. Cardiac arrest in the catheterisation laboratory: A 5year experience of using mechanical chest compressions to facilitate PCI during prolonged resuscitation efforts. Resuscitation 2010;81:383–387. Larsen AI, Hjornevik AS, Ellingsen CL, Nilsen DW. Cardiac arrest with continuous mechanical chest compression during percutaneous coronary intervention. A report on the use of the LUCAS device. Resuscitation 2007;75:454–459. Kalra A, Maharaj V, Johannsen RA, Hollenberg SM. Catheterization laboratory activation during mechanical cardiopulmonary resuscitation: When should we say “No?” Catheter Cardiovasc Interv 2014;83:58–64. Brown DF, Jaffer FA, Baker JN, Gurol ME. Case records of the Massachusetts General Hospital. Case 28-2013. A 52-year-old man with cardiac arrest after an acute myocardial infarction. N Engl J Med 2013;369:1047–1054. Kagawa E, Dote K, Kato M, Sasaki S, Nakano Y, Kajikawa M, et al. Should we emergently revascularize occluded coronaries for cardiac arrest? Rapid-response extracorporeal membrane oxygenation and intra-arrest percutaneous coronary intervention. Circulation 2012;126:1605–1613. Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, et al. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABPSHOCK II): Final 12 month results of a randomised, open-label trial. Lancet 2013;382:1638–1645.
Catheterization and Cardiovascular Interventions DOI 10.1002/ccd. Published on behalf of The Society for Cardiovascular Angiography and Interventions (SCAI).
